Senior Claims Auditor

2 weeks ago

Palo Alto, California, United States Machinify, Inc. Full time


Machinify, Inc. is an innovative healthcare technology firm dedicated to ensuring that patients receive optimal medical care, precisely when they need it, and at a fair cost.

Our advanced cloud-based Machinify AI platform harnesses cutting-edge machine learning, extensive data analytics, and cloud computing to address complex challenges, revolutionizing healthcare administration and payment processes.

We are currently in search of a Lead Auditor specializing in post-payment data analysis to perform comprehensive claims audits for our clients.

The successful candidate will also contribute to concept development, product evaluation, quality improvements, and other initiatives aimed at enhancing client satisfaction.

The ideal applicant will possess a robust background in healthcare claims auditing, claims processing, and coding, along with a deep understanding of payment regulations for CMS, Medicaid, and commercial payers.


Key Responsibilities:
  • Innovate auditing strategies by leveraging expertise in the claims payment cycle, contractual agreements, policies, and guidelines.
  • Execute thorough evaluations of post-payment claims utilizing all available resources, including claims data, client adjudication systems, compliance with regulatory standards, pricing systems, medical records, and authorizations.
  • Act as a billing and payment authority, serving as a resource for data teams and other departments.
  • Collaborate with the team to develop and enhance reimbursement policies and procedures.
  • Stay informed about the latest billing regulations and guidelines.
  • Meet or exceed client expectations for accuracy and quality in auditing concepts and valid claim identification.
  • Identify additional recovery opportunities outside of the established concepts and propose high-value auditing strategies and process enhancements.
  • Fulfill additional responsibilities as required to support organizational objectives.

Required Skills and Qualifications:
  • Over 10 years of relevant experience.
  • Ability to assess payment information against Medicare and payer billing standards to determine payment appropriateness.
  • Experience or certification in coding/billing is advantageous.
  • Proven ability to meet deadlines and work both independently and collaboratively.
  • Commitment to delivering high-quality work.
  • Exceptional attention to detail, along with strong investigative and analytical skills.
  • Proficient in utilizing enterprise productivity and communication tools (e.g., Excel, Word, Google Sheets, Slack) with intermediate spreadsheet skills, including the ability to manipulate data, use formulas, and run macros.

Preferred Skills (not mandatory for application):
  • Experience in post-payment data mining auditing.
  • Background in concept/trend development.
  • Experience in payer auditing.
  • Coding certification.

What We Offer:
  • Flexible remote work options across the US.
  • A supportive and empowering work environment.
  • Collaborative colleagues and a leadership team committed to attracting and retaining top talent.
  • Comprehensive Medical/Dental/Vision benefits for employees and their families.
  • Competitive salary, equity opportunities, 401(k) sponsorship, and life insurance.
  • Generous Learning and Development Reimbursement policy.

Machinify, Inc. is an equal opportunity employer, dedicated to hiring talented individuals from diverse backgrounds for all positions. We believe that embracing unique backgrounds, qualities, and cultures enriches our workplace.



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